scholarly journals Establishing the appropriate position of proximal humerus locking plates: a cadaveric study of five plating systems and their anatomic reference measurements

2017 ◽  
Vol 10 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Matthew A Butler ◽  
Aakash Chauhan ◽  
Gregory A Merrell ◽  
Jeffrey A Greenberg
Keyword(s):  
Humeral Head ◽  
First Generation ◽  
Second Generation ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Cadaveric Study ◽  
Locking Plates ◽  
Greater Tuberosity ◽  
Reference Measurements ◽  
Superior Border

Background The present study aimed to determine anatomic references for the placement of five proximal humerus locking plates. Methods Five proximal humerus locking-plate systems were placed on six human shoulder cadavers. Plates were positioned by fluoroscopic confirmation so that the inferior oblique screw was within 5 mm of the inferomedial cortex. Plate position was measured using the superior border of the pectoralis major tendon (PMT) to the bottom of the first slotted or nonlocking hole and top of the plate to the top of the greater tuberosity. The distance from the PMT insertion to the top of the humeral head was measured as a control. Results There was consistency within each plating system for both the distance from the PMT insertion to the first hole and the top of the plate to the greater tuberosity: Synthes first-generation [mean (SD) 13.7 mm (3.1 mm); 10 mm (1.3) mm], Synthes second-generation [28.2 mm (2.2 mm); 18.5 mm (2.7 mm)], Biomet OptiLock® [25.5 mm (2.7 mm); 18.7 mm (2 mm)], Stryker AxSOS® [5 mm (2.8 mm); 12.3 mm (3.3 mm)] and Acumed Polarus® [9.5 mm (1.8 mm); 14.8 mm (1.6 mm)]. Conclusions The present study provides measurements that improve the accuracy of plate positioning for five plating systems.

scholarly journals Digital analysis of external fixation area of proximal humerus fractures in elderly patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Baorui Xing ◽  
Yadi Zhang ◽  
Xiuxiu Hou ◽  
Yunmei Li ◽  
Guoliang Li ◽  
...  
Keyword(s):  
Humeral Head ◽  
3D Model ◽  
Proximal Humerus ◽  
Sagittal Plane ◽  
Axillary Nerve ◽  
Coronal Plane ◽  
Inferior Surface ◽  
Vertical Distance ◽  
Inferior Border ◽  
Superior Border

Abstract Introduction The purpose is based on anatomical basis, combined with three-dimensional measurement, to guide the clinical repositioning of proximal humeral fractures, select the appropriate pin entry point and angle, and simulate surgery. Methods 11 fresh cadaveric specimens were collected, the distance of the marked points around the shoulder joint was measured anatomically, and the vertical distance between the inferior border of the acromion and the superior border of the axillary nerve, the vertical distance between the apex of the humeral head and the superior border of the axillary nerve, the vertical distance between the inferior border of the acromion and the superior border of the anterior rotator humeral artery, and the vertical distance between the apex of the humeral head and the superior border of the anterior rotator humeral artery were marked on the 3D model based on the anatomical data to find the relative safety zone for pin placement. Results Contralateral data can be used to guide the repositioning and fixation of that side of the proximal humerus fracture, and uniform data cannot be used between male and female patients. For lateral pining, the distance of the inferior border of the acromion from the axillary nerve (5.90 ± 0.43) cm, range (5.3-6.9) cm, was selected for pining along the medial axis of the humeral head, close to the medial cervical cortex, and the pining angle was measured in the coronal plane (42.84 ± 2.45)°, range (37.02° ~ 46.31°), and in the sagittal plane (28.24 ± 2.25)°, range (19.22° ~ 28.51°). The pin was advanced laterally in front of the same level of the lateral approach point to form a cross-fixed support with the lateral pin, and the pin angle was measured in the coronal plane (36.14 ± 1.75)°, range (30.32° ~ 39.61°), and in the sagittal plane (28.64 ± 1.37)°, range (22.82° ~ 32.11°). Two pins were taken at the greater humeral tuberosity for fixation, with the proximal pin at an angle (159.26 ± 1.98) to the coronal surface of the humeral stem, range (155.79° ~ 165.08°), and the sagittal angle (161.76 ± 2.15)°, with the pin end between the superior surface of the humeral talus and the inferior surface of the humeral talus. The distal needle of the greater humeral tuberosity was parallel to the proximal approach trajectory, and the needle end was on the inferior surface of the humeral talus. Conclusion Based on the anatomical data, we can accurately identify the corresponding bony structures of the proximal humerus and mark the location of the pin on the 3D model for pin placement, which is simple and practical to meet the relevant individual parameters.

scholarly journals Fixation of proximal humerus fracture in adult by locking plate: Clinical study

2020 ◽  
Vol 6 (5) ◽  
pp. 325-332
Author(s):  
Dr. Vivek Amritbhai Patel ◽  
◽  
Dr. Vishal A. Pushkarna ◽  
Dr. Dhruvin J. Patel ◽  
◽  
...  
Keyword(s):  
Functional Outcome ◽  
Proximal Humerus Fracture ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Plate Fixation ◽  
Humeral Fracture ◽  
Humerus Fracture ◽  
Functional Evaluation ◽  
Locking Plates ◽  
Radiological Union

p>Aim: The present study aimed to examine the functional outcome of the locking plate in theproximal humerus fracture treatment. Material and Methods: The study consists of 20 patientsdiagnosed with NEER’s 2 – part, 3- part, and 4 – part proximal humerus fracture. All the includedpatients were treated with internal locking plates. Based on the functional evaluation by Constant-Murley shoulder score and the assessment of radiological union foundation. Results: Excellentresults were obtained in 45% of the patients, a good result was seen in 25%, 20% of the patientshad fair results and the poor result was seen in 10% of the patients. The mean Constant-Murleyshoulder score that was obtained in the present study was 75.04. Conclusion: It’s concluded thatthere is a satisfactory functional outcome with the fixation of the proximal humerus fracture withlocking plates. While using the plate fixation for fracture the plate position is of the utmostimportance. Due to angular stability, the locking plates are the advantageous implants in case ofproximal humeral fracture.

BIOMECHANICAL COMPARISON OF THE ROLE OF INLAY GRAFT IN PROXIMAL HUMERUS FRACTURE FIXED WITH CONVENTIONAL PLATE AND LOCKING PLATE

2013 ◽  
Vol 13 (04) ◽  
pp. 1350055 ◽  
Author(s):  
CHENG-HUNG LEE ◽  
KUI-CHOU HUANG ◽  
CHIH-KUN HSIAO ◽  
SUNG CHENG ◽  
YAU-CHIA LIU ◽  
...  
Keyword(s):  
Locking Plate ◽  
Proximal Humerus ◽  
Varus Deformity ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Locking Plates ◽  
Medial Support ◽  
Maximal Load ◽  
Conventional Plate

With a varus deformity, repairs of proximal humeral fractures frequently fail after screws pull out due to lack of medial support. Indirect intramedullary grafts have been used to prevent such complications. A biomechanical study was performed to investigate the role of an intramedullary bone peg (strut) in fractures fixed with conventional and locking plates. Twenty artificial proximal humerus specimens were divided into four groups. Group 1 specimens were fixed with convention plates and group 2 specimens were fixed with the addition of a bone peg. Groups 3 and 4 specimens were fixed using locking plate and additional bone peg, respectively. All specimens were tested with a static loading test, and the axial stiffness and maximal load were recorded. Locking plates with inlay graft were the most rigid of the four groups. When an intramedullary graft was introduced, the maximal load increased by more than 200%, whether conventional or locking plates were used. The maximal load of a conventional plate with inlay graft was more than twice of that of the locking plate only. Indirect medial support acts as an anti-bending device, reducing the tension on the plate. It also decreases varus deformity and loosening of screws. Locking plate stabilize the plate-bone interface. Locking plate with indirect medial support is thus recommended for patients withsevere osteoporotic or medial comminuted proximal humeral fractures.

scholarly journals Evaluation of mushroom-shaped allograft for unstable proximal humerus fractures

2020 ◽  
Author(s):  
Lukas Dankl ◽  
Werner Schmoelz ◽  
Romed Hoermann ◽  
Simon Euler
Keyword(s):  
Humeral Head ◽  
Locking Plate ◽  
Proximal Humerus ◽  
Treatment Options ◽  
Test Group ◽  
The Elderly ◽  
Bending Test ◽  
Control Group ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures

Abstract Introduction Proximal humerus fractures are common injuries of the elderly. Different treatment options, depending on fracture complexity and stability, have been recommended in the literature. Particularly for varus displaced fractures with a lack of medial support, and patients suffering from osteoporosis, structural allografts can be used to enhance the stability of the construct. An individually shaped allograft has been suggested in the literature and investigated in a clinical setting. However, biomechanical properties have yet to be evaluated. Materials and methods Twenty-four fresh-frozen humeri and 12 femoral heads were obtained, and an unstable three-part fracture of the humeral head was simulated. Fracture fixation was achieved by using a locking plate in both groups. In the test group, a mushroom-shaped allograft was tailored out of a femoral head to individually fit the void inside the humeral head. Specimens were fitted with a 3D motion analysis system and cyclically loaded with a stepwise increasing load magnitude in a varus-valgus bending test until failure or up to a maximum of 10,000 load cycles. Results The mushroom group reached a significantly higher number of load cycles (8342; SD 1,902; CI 7133–9550) compared to the control group (3475; SD 1488; CI 2530–4420; p < 0.001). Additionally, the test group showed significantly higher stiffness values concerning all observational points (p < 0.001). Conclusion This mushroom-shaped allograft in combination with a locking plate significantly increased load to failure as well as stiffness of the construct when exposed to varus-valgus bending forces. Therefore, it might be a viable option for surgical treatment of unstable and varus displaced proximal humerus fractures to superiorly prevent loss of reduction and varus collapse.

scholarly journals Pectoralis Major Tendon as Landmark for Proximal Humerus Surgery: A Cadaveric Study on the Adult Filipino Population

2021 ◽  
Vol 55 (3) ◽  
Author(s):  
Patrick M. Dizon ◽  
Daniel William T. Yu ◽  
Donnel Alexis T. Rubio
Keyword(s):  
Humeral Head ◽  
Proximal Humerus ◽  
Constant Factor ◽  
Pectoralis Major ◽  
Cadaveric Study ◽  
Proximal Humerus Fractures ◽  
Moderate Correlation ◽  
Humerus Fractures ◽  
Left And Right ◽  
Tendon Insertion

Objective. It is common to get lost during a comminuted proximal humerus surgery, and the pectoralis major insertion is always a constant. Therefore, this study aimed to do a cadaveric study on the Filipino population to assess the distance from the pectoralis major tendon to the top of the humeral head (PMT) as a reference during proximal humerus surgery. Methods. This study dissected the shoulders of cadavers. The distance from the pectoralis major tendon insertion to the top of the humeral head (PMT) was measured using a caliper. This PMT distance was also correlated to the cadaver's height and sex. Results. This study dissected 110 shoulders (55 cadavers | 24 females, 31 males). The median PMT was 5.40 cm for males and 4.90 cm for females, with a combined value of 5.40 cm overall. There was a direct and moderate correlation between the PMT with overall height. Height and PMT of both the left and right shoulder were significantly longer among males compared to females. The study showed that for every centimeter increase in the height of males, there was a corresponding 0.02 cm increase in the PMT, adding the constant factor of 1.83. A corresponding 0.04 cm increase in the PMT for females added the constant factor of -0.81. Conclusion. The pectoralis major tendon insertion is a consistent landmark that can accurately restore humeral length when reconstructing complex proximal humerus fractures where landmarks are otherwise lost because of comminution.

Hemiarthroplasty for proximal humerus fractures with conservation of the whole humeral head as autograft: does it improve greater tuberosity healing?

2018 ◽  
Vol 43 (5) ◽  
pp. 1155-1164
Author(s):  
Levon Doursounian ◽  
Julien Gaillard ◽  
Adeline Cambon-Binder ◽  
David Zbili ◽  
Alain Sautet
Keyword(s):  
Humeral Head ◽  
Proximal Humerus ◽  
Proximal Humerus Fractures ◽  
Greater Tuberosity ◽  
Humerus Fractures

scholarly journals The Distance between the Pectoralis Major Tendon Insertion and the Top of the Humeral Head is a Reliable Landmark: An Anatomic Study

Joints ◽  
2019 ◽  
Vol 07 (02) ◽  
pp. 037-040
Author(s):  
Dipit Sahu ◽  
Jairam D. Jagiasi ◽  
Anisha S. Valavi ◽  
Tushar Ubale
Keyword(s):  
Humeral Head ◽  
Reliable Method ◽  
Proximal Humerus ◽  
Pectoralis Major ◽  
Anatomic Study ◽  
Greater Tuberosity ◽  
Comminuted Fractures ◽  
The Mean ◽  
Tendon Insertion ◽  
Consistent Measurement

Abstract Purpose This study aimed to analyze the distance between the superior edge of the pectoralis major and the top of the humeral head and evaluate whether this distance is a consistent measurement. Methods Twenty-two shoulders in eleven cadavers were dissected and the attachment of the pectoralis major tendon was preserved. Two distances were recorded with the help of digital vernier caliper: the distance between the upper edge of pectoralis major and tangent to the top of humeral head (PM–T) and the distance between the superomedial tip of greater tuberosity (GT) and the upper edge of the pectoralis major tendon (PM–G; ± standard error of the means). Results The mean PM–T distance was 53.8 mm (±0.8 mm) and the mean PM–G distance was 46.8 mm (±0.9 mm). The distance between the top of humeral head and tip of the GT was 7 mm. The PM–T distance was a significant outlier in three shoulders as it inserted high on the humerus. Conclusion We can conclude that the PM–T and PM–G distances were a consistent measurement. Clinical Relevance The distance between the pectoralis major tendon and top of the humeral head was measured in this study as a reliable method that can be used intraoperatively to decide the height of the humerus prosthesis in comminuted fractures of the proximal humerus.

scholarly journals Digital Analysis of External Fixation Area of Proximal Humerus Fractures in Elderly Patients

2021 ◽  
Author(s):  
Yadi Zhang ◽  
Baorui Xing ◽  
Xiuxiu Hou ◽  
Yunmei Li ◽  
Guoliang Li ◽  
...  
Keyword(s):  
Humeral Head ◽  
3D Model ◽  
Proximal Humerus ◽  
Sagittal Plane ◽  
Axillary Nerve ◽  
Coronal Plane ◽  
Inferior Surface ◽  
Vertical Distance ◽  
Inferior Border ◽  
Superior Border

Abstract Background:The purpose is based on anatomical basis, combined with three-dimensional measurement, to guide the clinical repositioning of proximal humeral fractures, select the appropriate nail entry point and angle, and simulate surgery.Methods: 11 fresh cadaveric specimens were collected, the distance of the marked points around the shoulder joint was measured anatomically, and the vertical distance between the inferior border of the acromion and the superior border of the axillary nerve, the vertical distance between the apex of the humeral head and the superior border of the axillary nerve, the vertical distance between the inferior border of the acromion and the superior border of the anterior rotator humeral artery, and the vertical distance between the apex of the humeral head and the superior border of the anterior rotator humeral artery were marked on the 3D model based on the anatomical data to find the relative safety zone for nail placement.Results:Contralateral data can be used to guide the repositioning and fixation of that side of the proximal humerus fracture, and uniform data cannot be used between male and female patients. For lateral nailing, the distance of the inferior border of the acromion from the axillary nerve (5.90±0.43) cm, range (5.3-6.9) cm, was selected for nailing along the medial axis of the humeral head, close to the medial cervical cortex, and the nailing angle was measured in the coronal plane (42.84±2.45)°, range (37.02°~46.31°), and in the sagittal plane (28.24±2.25)°, range ( 19.22°~28.51°). The nail was advanced laterally in front of the same level of the lateral approach point to form a cross-fixed support with the lateral nail, and the nail angle was measured in the coronal plane (36.14±1.75)°, range (30.32°~39.61°), and in the sagittal plane (28.64±1.37)°, range (22.82°~32.11°). Two pins were taken at the greater humeral tuberosity for fixation, with the proximal pin at an angle (159.26±1.98) to the coronal surface of the humeral stem, range (155.79°~165.08°), and the sagittal angle (161.76±2.15)°, with the pin end between the superior surface of the humeral talus and the inferior surface of the humeral talus. The distal needle of the greater humeral tuberosity was parallel to the proximal approach trajectory, and the needle end was on the inferior surface of the humeral talus.Conclusion: Based on the anatomical data, we can accurately identify the corresponding bony structures of the proximal humerus and mark the location of the nail on the 3D model for nail placement, which is simple and practical to meet the relevant individual parameters.

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